Monthly Archives: March 2019

The Large Lecture: Minor Adjustments, Major Impacts

Large lecture courses are hard, for both students and faculty alike, and while an exhaustive body of Scholarship of Teaching & Learning (SOTL) research boasts benefits of smaller classes (Cuseo, 2007), budgetary and a myriad of other restrictions leave many higher education institutions with few options for reducing class sizes.  Accordingly, many instructors are forced to figure out a way to best serve our students in this unideal setting.

Three years ago, in my first year as a full time faculty member, I found myself teaching one of these large lecture classes.  There were ~250 students, split across two sections, piled into an outdated auditorium.   The setting was intimidating for me, and if one thing was certain, it was that however intimidated I felt, my students felt it even harder (and as an aside, three years later, I still find myself, at times, intimidated by this space).  So, in a high-stakes, pre-requisite course like Anatomy & Physiology that is content-heavy and, by nature, inherently intense, what can be done in a large lecture hall to ease the tension and improve student learning?

When looking to the SOTL research for evidence-based recommendations on student engagement and active learning ideas in high-enrollment courses such as mine, I quickly became overwhelmed with possibilities (not unlike a kid in a candy store).  Before I knew it, finding meaningful ways to reshape my class in the best interest of the student became defeating – how was I supposed to overhaul my course to integrate best-practice pedagogy while still juggling the rest of my faculty responsibilities?

Thankfully, last year a colleague introduced me to a book, Small Teaching: Everyday Lessons from the Science of Learning, by James Lang.  Admittedly – I still have not finished this book (rest assured – I am currently in a book club studying this book, so I WILL finish it!); that being said, Lang’s powerful message about the significance of small changes resonated with me pretty early on in the text.  Minor, thoughtful adjustments to the daily classroom routine are capable of eliciting substantial impacts on student learning.  In other words, I did not need to reinvent the wheel to better serve my students; instead, I set a goal for myself to try out one or two small, reasonable adjustments per semester.  While I am still navigating best-practice teaching and experience a healthy dose of trial-and-error, here is what I have found useful thus far:


1. Learning names. This is perhaps the most straightforward, obvious classroom goal, but when you have a large number of students, something as simple as learning student names can quickly slip through the cracks.  Now, I appreciate that implementing this goal takes considerable time and intention, and depending on the structure of your high-enrollment course, it may or may not be feasible.  In my course, for example, it is a two-part series, which means I have the same students for an entire academic year rather than one semester.  Moreover, in addition to lecture, I have all of my students in smaller lab sections.  Accordingly, I have plenty of opportunity to interact with students and pay attention to names.

From a purely anecdotal observation, if and when a student musters up the courage to ask a question in the large auditorium, addressing them by name appears to increase the likelihood of the student asking again.  Moreover, it seems to have an impact on other students in the classroom, too; anecdotally, I have noticed in lectures where I address student questions using student names, the number of different students asking questions appears to increase.  Overall, addressing students by name seems to communicate a message that students in our classrooms are not simply a body in a seat or a number in the system, but they are a member of a learning community.

2. Finding an inclusive platform for voicing questions. Despite reaching a point in the academic year where everyone knows each other by name, some students will never feel comfortable enough raising their hand to ask questions in the big lecture hall. Knowing this, along with the notion that student confusion rarely exist in isolation, this semester I made it a point to explore alternative platforms for asking questions during lecture.  Cue in the Google Doc: this handy, online word-processing tool gave me a platform for monitoring student questions in real time during lecture.  On the logistical end, it is worth noting that I have a TA monitoring our Google Doc during lecture, so that when a stream of questions comes through, common themes in questions are consolidated into one or two questions.  A few times during the lecture, I will check in with our TA and address questions.  It is also worth mentioning that the document has been set up such that student names are linked to their comments; this was implemented as a measure to keep comments appropriate and on track.  So far, this has turned out to be a great platform, not only for students asking lecture questions in real time, but also for facilitating some really great discussion amongst students.


3. Holding students accountable for in-class activities.  I quickly realized in my large lecture class that students were generally unmotivated to participate in any in-class activity unless I collected it and assigned points (which, by the way, can be a logistical nightmare with 250 students).  Yet, as I learned in Making it Stick: The Successful Science of Learning, by Brown, Roediger, and McDaniel (a previous book club endeavor of mine), engaging students in activities like 5 minute recall exercises is widely supported as an effective tool for long-term learning and retention.  So, I decided to piggy back off my previous idea of the Q&A Google Doc, and open up an entire classroom folder where, in addition to our Q&A doc, students had daily folders for submitting in-class activities (again, in real time).  As of now, the way that it works is as follows: upon completing the short recall exercise, or other in-class activity, students will snap a photo of their work and upload it to our Google drive.  Then, I choose a piece of student work to display as we review the activity prompt, which has proven to be a great method for maintaining student accountability (I disclosed to the students that I will randomly choose a few days in the semester to award extra credit for those who submitted during class).  Additionally, this provides quick feedback to me (in real time) regarding student comprehension and common misunderstandings; in fact, I will occasionally choose to review a student submission that represents a common mistake to highlight and address a common problem area.

In summary, implementing these small changes has offered realistic approaches to improving my students’ experience and creating community in an otherwise challenging setting: the large lecture.  While I retain other long-term teaching goals that require more of a time commitment, Lang’s sentiment that small ≠ insignificant provides a solid ground for improvement in the present.


Brown, PC, Roediger, HL, and McDaniel, MA (2014). Making it Stick: The Successful Science of Learning.  Cambridge, MA: Harvard University Press.

Cuseo, Joe. (2007). The empirical case against large class size: Adverse effects on the teaching, learning, and retention of first-year students. Journal of Faculty Development: 21.

Lang, James (2016).  Small Teaching: Everyday Lessons from the Science of Learning. San Francisco, CA: Jossey-Bass.


Amber Schlater earned her B.S. from the University of Pittsburgh in Biological Sciences, and her M.S. and Ph.D. from Colorado State University in Zoology; she also completed a two-year post-doctoral fellowship at McMaster University.  Currently, Amber is an Assistant Professor in the Biology Department at The College of Saint Scholastica in beautiful Duluth, MN, where she teaches Human Anatomy & Physiology, Super Physiology (a comparative physiology course), and mentors undergraduate research students.  Outside of work, Amber enjoys hiking, biking, camping, canoeing, and doing just about anything she can outside with her family.
The Teaching of Basic Science as a Necessity in the Doctor in Physical Therapy Clinical Curriculum

There is an ever increasing need to train evidenced-based clinicians among all the health disciplines. This is particularly true in the relatively young profession of physical therapy, where the educational standards have shifted from entry level bachelor’s degree requirements to clinical doctorate training. The increase in educational standards reflect the growth of the discipline, with an effort to increase the depth of knowledge and level of skill required to be a physical therapist while moving from technician to an independent direct access practitioner. This evolution also marks a shift in standards of evidenced-based practice from clinical observation to an ability to provide mechanistic understanding which includes fundamental scientific insights and transforms clinical practice. The profession also recognizes the need to advance the profession through research that provides a scientific basis validating physical therapy treatment approaches. As a result, there is an expanding, yet underappreciated role, for the basic science researcher / educator in Doctor of Physical Therapy (DPT) programs.

Strategies to integrate and infuse the basic science into practice:

1. Faculty training:

Big Four Bridge in Louisville, KY

How to bridge the gap between basic science and clinical education?  As dual credentialed physical therapist and basic scientist these influence Sonja’s teaching approach, to serve as a “bridge” between foundational science content and clinical application.  Teaching across broad content areas in a DPT curriculum provides opportunities to “make the connection” from what students learn in the sciences, clinical courses, and relate these to patient diagnosis and therapeutic approaches.

While dual training is one approach, these credentials combined with years of ongoing contemporary clinical practice, are rare and impractical to implement in an academic setting. Most often DPT programs rely on PhD trained anatomists, neuroanatomists, and physiologists to teach foundational courses, often borrowed from other departments to fulfill these foundational teaching needs. Thus, Chris’s approach is through crosstalk between scientist/physiologist and clinician to serve as a role model and teach the application of discoveries for identifying best evidence in clinical decision making. By either approach, we have become that key bridge teaching and demonstrating how foundational science, both basic and applied impact clinical decision making.

2. Placement of foundational science courses (physiology, neuroscience, anatomy):

Traditional curricular approaches introduce foundational sciences in anatomy, neuroscience, and physiology in the first year of the DPT curriculum, followed by clinical content with either integrated or end loaded clinical experiences over the course of remaining 2.5-3 years. Our current program established an alternative approach of introducing foundational sciences after the introduction of clinical content and subsequently followed by a full time clinical clerkship/ education. Having taught in both models, early or late introduction of foundational sciences, we recognized either partitioned approaches lead to educational gaps and makes bridging the knowledge to application gap challenging for students.

Regardless, the overall message is clear and suggestive of the need for better integration of foundational/scientific content throughout the curriculum. These challenges are not unique to physical therapy, as this knowledge to clinical translation gap is well documented in medicine and nursing and has been the impetus for ongoing curriculum transformations in these programs. These professions are exploring a variety of approaches on how to best deliver /package courses / and curriculum that foster rapid translation into clinical practice. Arena, R., et al., 2017; Fall, L.H. 2015; Newhouse, R.P. and Spring, B., 2010; Fincher et al., 2009.

Recently, new curricular models have emerged within the doctoral of physical therapy curriculum that complement the academic mission to train competent evidenced based clinicians Bliss et al., 2018, Arena R. et al. 2017. These models leverage the faculty expertise of physiologist/scientist, research, and clinical faculty to create integrative learning experiences for students. These models include integrated models of clinical laboratory learning and/ or classroom-based discussion of case scenarios, that pair the basic scientist and the clinical expert. It is our belief, that teaching our clinical students through these models will lead to enhanced educational experience, application of didactic course work, and the appreciation for high quality research both basic and applied.

3. Appreciation and value of foundational sciences through participation in faculty led research:

Capstone experiences are common curricular elements for the physical therapy profession. This model is believed to 1) prepare future physical therapy generations to provide high-quality clinical care and, 2) provide research needed to guide evidence-based care, and 3) foster the appreciation for evidence and advances in the field. We believe these pipeline experiences could allow for advanced training incorporating strong foundational (science) knowledge that is relevant to the field, which can be applied broadly and adapted to integrate the rapidly growing knowledge base. Such models may assist in integrating the importance of scientific findings (basic and applied) while facilitating the breakdown of barriers (perceived and real) that silo clinical and foundational content (Haramati, A., 2011).

Contributing to the barriers are that relatively few of the basic sciences and translational studies are being conducted by rehabilitation experts. Furthermore, like medicine disciplines, it is unlikely that DPT faculty will be experts as both a clinician and scientist. Rather these emerging models promote teams of scientists and clinical faculty who work together to promote scientific, evidence-based education (Polancich S. et al., 2018; Read and Ward 2017; Fincher et al., 2009). Implementation of these education models requires “buy in” from administration and faculty who must recognize and value a core of outstanding clinician-educators, clinician-scientists, and basic scientists, and reward effective collaboration in education (Fincher 2009).

Although these models are flowering in research intensive universities, the challenges of integrating the basic sciences are greater in programs embedded within smaller liberal arts institutions that lack the infrastructure and administrative support for creating teaching-science-clinical synergies. Often these programs are heavily weighted towards clinical education faculty who emphasize clinical teaching and development of clinical skills, with a less integrated emphasis on the fundamental science in clinical decision making. Our own experience, having taught foundational (physiology and neuroscience) sciences, are that faculty in these programs are more reluctant to embrace and value foundational sciences. A possible explanation may be the limited exposure to and unrecognized value of contributions to the field from such basic and translational approaches. It is frequently implied if it works, it may not be necessary to understand mechanistically how it works. While this might suffice for today’s practice approach, this will not be enough for future clinicians in a rapidly evolving clinical environment. Programs that may not foster scientific curiosity, may be missing the opportunity to instill lifelong learning. We agree with other educators that the integration of basic science is critical for the student progress toward independence and essential competence, and that health science educators should support the teaching of basic science as it aids in the teaching of how to solve complex clinical scenarios even if clinicians may not emphasize the basic science that underlies their reasoning (Pangaro, 2011).

Concluding Thoughts:

Physical therapy departments particularly those within major academic centers housing a mix of research, education, and clinically focused faculty can successfully operate a curriculum able to synergize education, research, and clinical initiatives. Creating synergies early in a curriculum by pairing clinical specialists with science trained faculty will facilitate connections between clinical practice and science (Bliss, et al., 2018). While curricular change can be challenging, programs that implement a collaborative model where faculty with a shared area of expertise (e.g., orthopedics, neurology, cardiopulmonary, pediatrics and geriatrics) and unique complementary skill sets (i.e., research, education, and clinical practice) come together to transform student educational experiences – completing that bridge between basic science and clinical practice.

Stacked Stone Arch



Arena, R., Girolami, G., Aruin, A., Keil, A., Sainsbury, J. and Phillips, S.A.,

Integrated approaches to physical Therapy education: a new comprehensive model from the University of Illinois Chicago, Physiotherapy Theory and Practice, 2017, 33:5, 353-360, doi: 10.1080/09593985.2017.1305471.

Bliss, R., Brueilly, K. E., Swiggum, M. S., Morris, G. S., Williamson, E.M., Importance of Terminal Academic Degreed Core Faculty in Physical Therapist Education, Journal of Physical Therapy Education. 2018, 32(2):123-127, doi: 10.1097/JTE.0000000000000054.

Fall, L.H., The Collaborative Construction of the Clinical Mind: Excellence in Patient Care through Cognitive Integration of Basic Sciences Concepts into Routine Clinical Practice, Med.Sci.Educ. 2015, 25(Suppl 1): 5, doi: 10.1007/s40670-015-0192-9.

Fincher, M., Wallach P., and Richardson, W.S.,  Basic Science Right, Not Basic Science Lite: Medical Education at a Crossroad, J Gen Intern Med. 2009, Nov; 24(11): 1255–1258, doi: 10.1007/s11606-009-1109-3

Haramati, A., Fostering Scientific Curiosity and Professional Behaviors in a Basic Science Curriculum, Med.Sci.Educ. 2011, 21(Suppl 3): 254, doi: 10.1007/BF03341720.

Newhouse, R.P. and Spring, B., Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy, Nurs Outlook. 2010, Nov–Dec; 58(6): 309–317, doi: 10.1016/j.outlook.2010.09.001.

Pangaro, L., The Role and Value of the Basic Sciences in Medical Education: The Perspective of Clinical Education -Students’ Progress from Understanding to Action. Medical Science Educator. 2010, Volume 20: No. 3. 307-313.

Polancich, S., Roussel, L., Graves, B.A., O’Neal, P.V., A regional consortium for doctor of nursing practice education: Integrating improvement science into the curriculum. J Prof Nurs. 2017, Nov – Dec;33(6):417-421, doi: 10.1016/j.profnurs.2017.07.013.

Read C.Y., Ward L.D., Misconceptions About Genomics Among Nursing Faculty and Students. Nurse Educ. 2018, Jul/Aug;43(4):196-200, doi: 10.1097/NNE.0000000000000444.



Chris Wingard completed his BA in Biology form Hiram College a MS from University of Akron and PhD from Wayne State University. He has served in physiology departments at University of Virginia, Medical College of Georgia and East Carolina University during his career and has most recently joined the Bellarmine University College of Health Professions as Professor teaching in the Physical Therapy, Accelerated Nursing and Biology Programs.  His interests are in the impacts of environmental exposures on the function of the cardiovascular pulmonary systems.
Sonja Bareiss received a BS in Biology and Master’s in Physical Therapy from Rockhurst University. She completed her PhD in Anatomy and Cell Biology at East Carolina University. Dr. Bareiss was a faculty member at East Carolina University Department of Physical Therapy and Department of Anatomy and Cell Biology before joining the DPT program at Bellarmine University. Her areas of teaching span foundational sciences (neuroscience and anatomy) to clinical content (electrical modalities). Her most recent efforts have been to develop and implement a pain mechanisms and management course into physical therapy curriculum with emphasis on interdisciplinary learning. In addition to her academic experience, Dr. Bareiss has over 8 years of full-time clinical experience where she specialized in treating patients with chronic pain syndromes. Her research and clinical interests have been dedicated to understanding mechanisms of neural plasticity related to the development and treatment of pain and neurodegenerative disease and injury and integrating undergraduate Biology Honors and DPT students into the work.